Vanderbilt University Medical Center Advanced Practice Orientation - PowerPoint PPT Presentation

Vanderbilt University Medical Center Advanced Practice Orientation

Agenda Advanced Practice at Vanderbilt – Overview • Shared Governance, Professionalism and Collaboration • Credentialing and Privileging • Tennessee Guidelines for Practice • Prescribing in Tennessee • Vanderbilt University Medical Center Guidelines for Advanced Practice (Bylaws, policies, eStar) • National Guidelines for Advanced Practice • VUMC Advanced Practice – Professional Practice Evaluation • Disclosure Training • Risk Management Training • Orientation Packet and Checklist • Office of Advanced Practice Virtual Tour •

Advanced Practice Overview Welcome to VUMC Advanced Practice – Your Journey Begins Here!

History Image goes here In the 1960s – the first NP, CNM, CRNA and PA programs were launched. In 2004, VUMC had 100 APRNs and PAs. Today, the U.S. has over 300,000 APRNs and 100,000 PAs. And VUMC has grown to over 1000! Nurse Practitioners >745 • Certified Registered Nurse Anesthetists >155 • Certified Nurse Midwives >50 • Clinical Nurse Specialists >20 • Physician Assistants >60 •

Magnet Designation Image goes here “ . . person, place, object, or situation that exerts • attraction” Commitment, Quality, & Excellence In Nursing • Awarded by American Nurses Credentialing • Center (ANCC) 9% of US hospitals designated • In 2017, VUMC received its 3 rd Magnet • Designation!

Magnet Professional Practice Model Image goes here Evidence based practice • Quality, safety, service • Professionalism and Leadership • Integrated Technology • Essential Components of the Magnet Model Transformational Leadership • Structural Empowerment • Exemplary Professional Practice • New Knowledge, Innovations & • Improvements Outcomes •

Shared Governance “A commitment to others to have an Image goes here active voice and participation in improving practice in collaboration leaders.” Shared Governance supports: Decentralized decision making • Shared accountability • Partnerships to deliver • VUMC Advanced Practice Committees: Advanced Practice Standards • Advanced Practice Professional Development • Advanced Practice Council • Advanced Practice Leadership Board •

Professionalism, Collaboration and Teamwork It’s the Vanderbilt Team that Makes all the Difference!

Building Relationships Image goes here Nursing CREDO Behaviors • Service is the HIGHEST priority • Communicate effectively • Professional self ‐ conduct • Committed to my colleagues • Maintain self ‐ awareness • Physicians Promote trust & credibility • Integrated into care • Continuous presence • Increase knowledge & expertise •

Collaboration Image goes here “. . joint & cooperative, integrates individual perspectives & expertise of team members” (Resnick & Bonner, 2003, p. 344) Collaboration… Enhances empowerment • Increases job effectiveness and satisfaction • Associated with improvements in patient • outcomes, healthcare costs and decision ‐ making.

APRN/PA Patient Care Center Name Title (PCC), Hospital or Area CRNA/VPEC Brent Dunworth, DNP, CRNA Director/Chief CRNA MEDICINE Jane Case, DNP, FNP Director NEUROSCIENCES Briana Witherspoon, DNP, ACNP Director OBGYN ‐ DEPT Angela Wilson ‐ Liverman, MBA, CNM Director SURGERY Heather Jackson, PhDc, APRN Assistant Director TRANSPLANT Deonna Moore, PhD, ACNP Director VCH Acute and Critical Care Michelle Terrell, DNP, PNP, AC/PC Director VCH Acute and Outpatient Care Jill Kinch, MMHC, PNP, AC/PC Director VHVI Tiffany Street, DNP, ACNP Director VICC Kiersten LeBar, DNP, PNP, AC/PC Director School of Nursing Nurse Faculty Lori Crews, MSN, FNP and Melissa Director Practices and Midwifery Davis, DNP, CNM PSYCHIATRY Molly Butler, MSN, PMHNP Team Lead OCCUPATIONAL HEALTH Clinical Manager Catherine Qian, MSN, FNP ORTHOPAEDICS Mary Duvanich, RN Administrative Director Vanderbilt Health Oncall Jennifer Mitchell MSN ANP Director

Which does NOT describe a Magnet designated facility? A. Committed to quality and excellence in nursing B. Awarded by Centers for Medicare/Medicaid (CMS) C. Only 9% of US hospitals have designation D. Awarded by American Nurses Credentialing Center (ANCC)

Which describes the culture of shared governance? A. Advocacy of active voice B. Commitment to active participation C. Improving practice through collaboration D. All of the above

Which is not true about collaboration? A. Includes perspectives & expertise of team members B. Enhances empowerment C. Decreases job satisfaction D. Is associated with improved patient outcomes

Credentialing and Privileging “It is truly a privilege to care for patients within Vanderbilt Medical Center”

Nu Nurse Practition titioner an and Ph Physician ician Ass Assistant Deline Delineatio tion of of Cor Core Priv ivileg ileges (DO (DOP) Core  Obtain and document a health history;  Perform and document complete, system ‐ focused, or symptom ‐ specific physical examination;  Assess the need for and perform additional screening and diagnostic testing, based on initial Privileges assessment findings;  Prioritize data collection;  Perform daily rounds/clinic visits on assigned patient population;  Document daily progress notes, plan of care, evaluation and discharge summary;  Manage diagnostic tests through ordering and interpretation;  Formulate differential diagnoses by priority;  Prescribe appropriate pharmacologic and non ‐ pharmacologic treatment modalities.  Utilize evidence ‐ based, approved practice protocols in planning and implementing care;  Initiate appropriate referrals and consultations;  Provide specialty specific consultation services upon request and within specialty scope of practice;  Facilitate the patient’s transition between and within health care settings, such as admitting, transferring, and discharging patients.  Demonstrate competency specific to the patient population of care, as indicated in area specific competency training, assessment and validation process.

Certified Certified Re Regist stered Nu Nurse Anes esthet thetis ist:  Performance of pre ‐ anesthetic assessments including a pertinent medical history, physical examination, and review of medical records  Formulation of an anesthetic care plan in consultation with the assigned anesthesiologist  Induction and maintenance of anesthesia with all commonly used agents and monitoring devices; management of emergence from anesthesia; airway maintenance including bag/mask ventilation, laryngeal mask airways, and intubation of the trachea  Anticipating and identifying common complications during the perioperative period, initiating treatment as indicated, and communicating problems to the anesthesiologist supervising the specific case or other appropriate staff members  Anesthetic management of urgent and emergent conditions  All elements of CRNA scope of practice as recommended by the AANA Scope and Standards for Nurse Anesthesia Practice document Certified Certified Nu Nurse Mi Midwife:  Perform and document complete, system ‐ focused, or symptom ‐ specific physical examination;  Assess the need for and perform appropriate screening and diagnostic testing.  Formulate differential diagnoses by priority.  Manage diagnostic tests through ordering and interpretation.  Prioritize data collection.  Perform daily rounds/clinic visits on assigned patient population.  Document daily progress notes, plan of care, ongoing evaluation and discharge summary.  Prescribe appropriate pharmacologic and non ‐ pharmacologic treatment modalities.  Utilize evidence ‐ based, approved practice guidelines in planning and implementing care.  Initiate appropriate referrals and consultations.  Provide specialty specific consultation services upon request and within specialty scope of practice.  Facilitate the patient’s transition between and within health care settings, such as admitting, transferring, and discharging.  Core procedures as incorporated in ACNM Core Competencies for Basic Midwifery Practice, latest edition, are hereby incorporated by reference .

Core Privileges Basic delineation of privileges to practice as an advanced practitioner • These are essential to the role, the main responsibilities for practice • DOP available for NP, CNS, PA, CNM, CRNA • All practitioners must apply for and be approved for core privileges • Process for approval Complete one packet (every single document!) • 90 ‐ 120 days for verification and review • File goes to Joint Practice for recommendation • File goes to VUMC Credentials Committee for recommendation • File goes to Medical Center Medical Board for recommendation • File goes to Board of Directors for final approval •